title: Percutaneous endoscopic gastrostomy in paediatric practice: complications and outcome.
abstract: OBJECTIVE
  The aim of this study was to establish the morbidity and mortality of percutaneous endoscopic gastrostomy (PEG) in a tertiary referral paediatric practice and to identify risk factors for developing complications after a PEG.
  
  
  METHODS
  The medical records of all patients who had a percutaneous endoscopic gastrostomy attempted over a 5-year period (1990 to 1995) were reviewed.
  
  
  RESULTS
  One hundred thirty percutaneous gastrostomies were placed in 120 paediatric patients. Indications for insertion were inability to swallow (n = 74, of which, 52 were neurologically impaired), inadequate calorie intake (n = 30), special feeding requirements (n = 12), continuous enteral feeding in short gut (n = 2), and malabsorption (n = 2). All the children had complex medical problems, and 80% of the patients were rated as "high risk" for general anaesthesia (> or = ASA grade 3). Major complications developed in 21 children (17.5%) and minor complications in 27 (22.5%). Of the 17 children in whom gastroesophageal reflux (GOR) became symptomatic, 10 required a Nissen fundoplication. Nine of these 10 children were neurologically impaired (19% of the neurologically impaired children). One postrenal transplant patient on immunosuppression died 54 days after the procedure of intraabdominal sepsis. Thirty-one patients required secondary surgical procedures.
  
  
  CONCLUSIONS
  PEG is associated with significant morbidity. Neurologically impaired children are at risk of acquiring symptomatic GOR, but the risk does not warrant routine fundoplication. Major complications are common and need urgent surgical consultation with many requiring secondary surgical procedures. PEG in paediatric patients should be considered a major surgical undertaking.
authors.affiliation: Great Ormond Street Hospital for Children, London, England.
authors.forename: I U
authors.initials: IU
authors.lastname: Khattak
authors.forename: C
authors.initials: C
authors.lastname: Kimber
authors.forename: E M
authors.initials: EM
authors.lastname: Kiely
authors.forename: L
authors.initials: L
authors.lastname: Spitz
mesh_terms: D002648:Child; D004724:Endoscopy / Q000009:adverse effects*; D004750:Enteral Nutrition / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors